Medical Billing Services in Connecticut
Billing, coding, credentialing and denial management for Connecticut practices, with Medicare claims through National Government Services (Jurisdiction JK) and Connecticut Medicaid handled by people who know the rules.
Medical billing for Connecticut practices
Connecticut runs its Medicaid program, HUSKY Health, without capitated managed care plans. The Department of Social Services pays claims through its fiscal agent, Gainwell Technologies, and contracts with administrative service organizations for care management. Medicare Part B is processed by National Government Services in Jurisdiction K, and the commercial market includes payers headquartered in the state, including Aetna and Cigna, along with Anthem and ConnectiCare.
Practices in Hartford, New Haven, Stamford and Bridgeport often see patients who work in New York or Massachusetts and carry out-of-state coverage. SFA Solutions works with practices across Connecticut remotely. We work inside your existing EHR, submit most clean claims within 24 hours, check each patient's coverage before the visit and follow up on unpaid claims.
Connecticut at a glance
| Medicare contractor | National Government Services, Jurisdiction JK |
|---|---|
| Medicaid timely filing | One year from the date of service, with exceptions such as retroactive eligibility (one year from the date eligibility is added) and other insurance (one year from the other payer's denial) |
| NP practice authority | Full |
| Cities we serve | Bridgeport, Stamford, New Haven, Hartford, Waterbury, Norwalk, Danbury, New Britain, Greenwich |
What Connecticut billing involves
These are the programs and rules our team works with for Connecticut claims.
Medicare
National Government Services · JKConnecticut Part B claims are processed by National Government Services in Jurisdiction JK. Medicare's filing limit is 12 months from the date of service, and appeals start with a redetermination within 120 days of the initial decision.
Connecticut Medicaid
HUSKY Health (HUSKY A, C and D for Medicaid; HUSKY B for CHIP), administered by the Connecticut Department of Social Services
Portal: Connecticut Medical Assistance Program secure web portal at ctdssmap.com, operated by the fiscal agent Gainwell Technologies, for enrollment and claims
Medicaid managed care
Connecticut does not use capitated Medicaid managed care plans. Claims are paid fee-for-service by the state, and administrative service organizations handle care management, including Community Health Network of Connecticut for medical services and Carelon Behavioral Health for behavioral health.
Timely filing
One year from the date of service, with exceptions such as retroactive eligibility (one year from the date eligibility is added) and other insurance (one year from the other payer's denial).
Commercial and Medicare Advantage
Anthem Blue Cross and Blue Shield, ConnectiCare, Aetna, Cigna and UnitedHealthcare (including Oxford) are the largest commercial payers. Out-of-state plans from New York and Massachusetts are common near the borders.
Prompt pay law
Conn. Gen. Stat. 38a-816(15) requires insurers to pay interest on a claim with all information needed for payment that is not paid within 45 days of receipt. If information is missing, the insurer must request it within 30 days and pay within 30 days after receiving it.
Nurse practitioners
Full practiceConnecticut APRNs can practice without a collaborative agreement after holding a license for at least three years and practicing for at least three years and 2,000 hours in collaboration with a physician. Until then, payers may ask for collaboration documentation during credentialing.
Credentialing
Providers enroll in the Connecticut Medical Assistance Program through Gainwell at ctdssmap.com, and every ordering, referring and rendering provider needs an active enrollment. Anthem, ConnectiCare, Aetna and Cigna rely on CAQH ProView for commercial credentialing. Medicare enrollment goes through PECOS with NGS.
Billing challenges Connecticut practices face
State-run Medicaid billing
Because HUSKY Health claims go directly to the state fiscal agent, there are no plan-level rules to lean on, and state edits apply to every claim. Rejected claims must be corrected and resubmitted inside the state filing window. A daily review of the remittance advice catches problems early.
Out-of-state commercial plans
Many Connecticut patients carry coverage through New York or Massachusetts employers. Those claims often go through the BlueCard program or an out-of-area network, which adds steps and delays. Correct payer identification at check-in keeps them moving.
Prior authorization volume
Commercial carriers in Connecticut require prior authorization for many imaging studies, specialty drugs and procedures. A missing authorization number is one of the most common causes of denials. We track authorization requirements by payer and service to help keep claims from going out without them.
Our services in Connecticut
Medical Billing
Learn moreCredentialing & Payer Enrollment
Learn moreMedical Coding
Learn moreDenial Management
Learn moreA/R Recovery
Learn moreEligibility Verification & Prior Authorization
Learn moreMedical Billing Audit
Learn moreRevenue Cycle Management
Learn moreSpecialties we bill in Connecticut
Connecticut medical billing questions
What is the timely filing limit for Connecticut Medicaid?
HUSKY Health claims must be submitted within one year of the date of service. Exceptions include retroactive eligibility, which allows one year from the date eligibility is added, and claims first denied by another insurer. Most clean claims are submitted within 24 hours, well ahead of that deadline.
Does Connecticut Medicaid use managed care plans?
No. HUSKY Health is a fee-for-service program paid by the state through Gainwell Technologies. Administrative service organizations provide care management, but they do not pay claims as a health plan would.
How fast must Connecticut insurers pay claims?
Under Conn. Gen. Stat. 38a-816(15), insurers owe interest on a complete claim not paid within 45 days of receipt. If information is missing, the insurer has 30 days to ask for it and 30 days after receiving it to pay.
Who is the Medicare contractor for Connecticut?
National Government Services processes Medicare Part B claims for Connecticut under Jurisdiction K, which also covers New York and the rest of New England. Enrollment changes go through PECOS.
Get a free billing audit for your Connecticut practice
We will review your recent claims and denials against Connecticut payer rules and show you what can be recovered.
Nearby states
Primary sources
- CMS: Who are the MACs, A/B MAC Jurisdiction K (JK)
- CT DSS Waiver Provider Workshop 2024 (timely filing)
- Connecticut Insurance Department Bulletin HC-56 (C.G.S. 38a-816(15))
- Connecticut DPH: APRN practice without a collaborative agreement
Payer rules change. Last reviewed against the primary sources above on . Confirm current rules with the payer before relying on them.
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